Post-Prandial Carbohydrate Metabolism in Individuals With and Without Post-Bariatric Surgery Hypoglycemia (PBH)

Inclusion Criteria

• Age 18-70 years of age, inclusive, at screening.
• Willingness to provide informed consent and follow all study procedures, including attending all scheduled visits.
• Males or females at least 2 years following Roux-en-Y gastric bypass (RYGB)
• For patients recruited to PBH group: diagnosed with ongoing PBH, with documented episodes of hypoglycemia, and history of fulfillment of Whipple's triad.

Exclusion Criteria

• Documented hypoglycemia occurring only in the fasting state (>12 hours fast);
• Current diabetes, defined as hemoglobin A1c >6.5% or use of diabetes medications, except for acarbose or miglitol;
• Chronic kidney disease stage 4 or 5 (including end-stage renal disease);
• Hepatic disease, including serum ALT or AST greater than 2 times the upper limit of normal; hepatic synthetic insufficiency as defined as serum albumin \< 3.0 g/dL; or serum bilirubin > 2.0;
• Congestive heart failure, NYHA class II, III or IV;
• History of myocardial infarction, unstable angina or revascularization within the past 6 months.
• Two or more risk factors for coronary artery disease including diabetes, uncontrolled hypertension, uncontrolled hyperlipidemia, and active tobacco use.
• History of recurrent syncope (unrelated to hypoglycemia) or active diagnosis of a cardiac arrhythmia;
• Current administration of β-blocker therapy;
• History of a cerebrovascular accident;
• Seizure disorder (other than with suspect or documented hypoglycemia);
• Active treatment with long-acting (LAR) octreotide or pasireotide;
• Active malignancy, except basal cell or squamous cell skin cancers;
• Personal or family history of pheochromocytoma or disorder with increased risk of pheochromocytoma (MEN 2, neurofibromatosis, or Von Hippel-Lindau disease);
• Known insulinoma;
• Major surgical operation within 30 days prior to screening;
• Clinically significant anemia as defined as a hematocrit \< 33%;
• Bleeding disorder, treatment with warfarin, or platelet count \<50,000;
• Blood donation (1 pint of whole blood) within the past 2 months;
• Active alcohol abuse or substance abuse;
• Current administration of oral or parenteral corticosteroids;
• Pregnancy and/ or lactation: For persons of childbearing potential: there is a requirement for a negative urine pregnancy test before any procedures.
• Not enrolled in another study that uses an investigational drug for this condition.